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Psychiatric / Mental Health Nursing Cognitive Disorders West Coast University NURS 204 What are cognitive disorders? Delirium Dementia Amnestic disorders Etiology Delirium An underlying systemic illness, including infection, and endocrine disorder, trauma, and drug/alcohol abuse Dementia Classified as to the cause or area of brain damage Amnestic disorders Head trauma, hypoxia, encephalitis, thiamine deficiency, and substance abuse Theories Genetics Dementia of Alzheimer’s type Dementia from Huntington’s disease Dementia from Pick’s disease Theories - continued Infection Delirium Dementia from Creutzfeldt–Jakob disease Parkinson’s disease Amnestic disorders Vascular insufficiency Brain tissue destroyed Symptoms absent until 100–200 cc of brain tissue destroyed Underlying systemic illness or injury Delirium Amnestic disorders Differentiating Types of Cognitive Disorders Delirium Acute confusional state characterized by disruptions in thinking, perception, & memory Dementia Chronic state characterized by declines in multiple cognitive areas, including memory Amnestic disorders Uncommon cognitive disorder characterized by amnesia Amnestic Disorder Characterized by short-and long-term memory deficits Inability to recall previously learned information or past events Inability to learn new materials Cofabulation, apathy, bland affect Amnestic disorder NOS: not enough supporting evidence to link a cause to the amnesia (medical or substance) Delirium and Dementia Differences Delirium Fluctuating consciousness Varying attentiveness Acute Rapid onset Cause is identifiable Generally reversible Delirium and Dementia Differences - continued Dementia Stable levels of consciousness Steady attentiveness Chronic Slow insidious onset Undetermined cause Generally irreversible Depression Depression can be masked by symptoms suggestive of dementia The term pseudodementia is used to describe the reversible cognitive impairments seen in depression Pseudodementia is characterized by an abrupt onset, rapid clinical course, and client complaints about cognitive failures Assessment Delirium Fluctuating levels of consciousness Disorientation and sundowning Impaired reasoning Poor attention span Altered sleep–wake cycle Alternating patterns of motor behavior Assessment - continued Dementia Memory impairment Cognitive impairment Aphasia Apraxia Agnosia Poor judgment Decline in previous abilities Interventions for Delirium Introduce self and call client by name at each contact Maintain face-to-face contact Use short, concrete phrases Keep room well lit Keep environmental noise low Set limits on behavior 1:1 staffing as needed Interventions for Dementia Gently orient the client Educate family about home safety Maintain optimal nutrition Bowel and bladder training Utilize nonverbal forms of communication Structure the environment to support cognitive functions Supporting Optimal Memory Functioning Environmental reminders Reminiscence activities Triggers for semantic memory Support cognitive strengths Assist to cope with cognitive deficits Common Medications for Cognitive Disorders Dementia of the Alzheimer’s Type (DAT) Donepezil (Aricept) Galantamine (Reminyl) Rivastignime (Exelon) Slows the rate of cognitive decline Potent acetylcholinesterase inhibitors Common Medications for Cognitive Disorders Dementia with Lewy Bodies Escitalopram (Lexapro) Reduce symptoms of depression when present Pick’s Disease Valproic Acid (Depakote) Reduce problematic mood swings and agitated behavior Vascular Dementia with psychosis Quetiapine (Seroquel) Reduce or eliminate delusions and hallucination Caregiver Difficulties Wandering behaviors Sundowning disorientation ADLs Medication management Burnout and fatigue Caregiver Resources Family meetings Alzheimer’s Disease and Related Disorders Association (ADRDA) Caregiver support groups Identify community resources ID bracelet for the client Self-Awareness Caring for clients with cognitive disorders can be difficult and frustrating at times. Self-awareness inventory in your text The responses are designed to help you to become more successful in working with cognitively impaired clients and their families. Review Question Delirium is thought to be caused primarily by: A. Genetics. B. Underlying systemic illness. C. Brain injury. D. Vascular insufficiency. Review Question A key characteristic of an amnestic disorder is: A. Short-term and long-term memory loss. B. Hallucinations. C. Long-term memory loss. D. Short-term memory loss. Review Question A caregiver for a client diagnosed with dementia of the Alzheimer’s type is unable to effectively communicate with the client. Which of the following techniques would be most appropriate to teach the caregiver? A. Setting strict time limits and rephrasing misunderstood questions B. Using multiple memory cues and giving several directions at once C. Correcting errors by the client, and speaking in a loud clear voiced. D. Encouraging verbal and nonverbal communication, while maintaining a calm demeanor Review Question The home health nurse is instructing a family who cares for a patient with dementia alzheimer’s type about safety measure would include: A. Putting locks on the outside of doors so the patient can not leave the room or house B. Purchasing a MedicAlert bracelet that identifies the client as having DAT C. Chemically restraining the patient to prevent agitation and confusion D. Restraining the patient in a chair or bed to prevent falls Review Question The actual cause of dementia associated with dementia of the Alzheimer’s Type is: A. Diabetes B. Infection C. Unknown D. Head trauma E. Drug intoxication Review Question One of the difference between delirium and dementia is that clients with delirium: A. Are very attentive B. Experience a slow, insidious onset of symptoms C. Have fluctuating consciousness D. Respond to questions appropriately and correctly